Oral and Topical Vitamin D, Sunshine, and UVB Phototherapy Safely Control Psoriasis in Patients with Normal Pretreatment Serum 25-Hydroxyvitamin D Concentrations: A Literature Review and Discussion of Health Implications

Abstract

Vitamin D, sunshine and UVB phototherapy were first reported in the early 1900s to control psoriasis, cure rickets and cure tuberculosis (TB). Vitamin D also controlled asthma and rheumatoid arthritis with intakes ranging from 60,000 to 600,000 International Units (IU)/day. In the 1980s, interest in treating psoriasis with vitamin D rekindled. Since 1985 four different oral forms of vitamin D (D2, D3, 1-hydroxyvitaminD3 (1(OH)D3) and 1,25-dihydroxyvitaminD3 (calcitriol)) and several topical formulations have been reported safe and effective treatments for psoriasis—as has UVB phototherapy and sunshine. In this review we show that many pre-treatment serum 25(OH)D concentrations fall within the current range of normal, while many post-treatment concentrations fall outside the upper limit of this normal (100 ng/mL). Yet, psoriasis patients showed significant clinical improvement without complications using these treatments. Current estimates of vitamin D sufficiency appear to underestimate serum 25(OH)D concentrations required for optimal health in psoriasis patients, while concentrations associated with adverse events appear to be much higher than current estimates of safe serum 25(OH)D concentrations. Based on these observations, the therapeutic index for vitamin D needs to be reexamined in the treatment of psoriasis and other diseases strongly linked to vitamin D deficiency, including COVID-19 infections, which may also improve safely with sufficient vitamin D intake or UVB exposure.

The Effect of Three-Month Vitamin D Supplementation on the Levels of Homocysteine Metabolism Markers and Inflammatory Cytokines in Sera of Psoriatic Patients

“…Our study showed that after three months of vitamin D supplementation, as many as 80% of patients had achieved the optimal vitamin D concentrations and this effect correlated with clinical improvement of skin lesions, as judged by the decreased PASI scores. These results are in accordance with previous findings which were systematized in a very recent review [ 25 ]. Such a clinical improvement was expected, as the relationship between vitamin D deficiency and psoriasis is well established [ 26 ].…”

Vitamin D and Rheumatic Diseases: A Review of Clinical Evidence

“…This could explain the observation that serum 25(OH)D was inversely correlated with presence of PsA [ 95 ], as well as plasma C-reactive protein level among patients with PsA [ 96 ]. Moreover, some reports have shown marked clinical improvement in patients with psoriasis who received up to 50,000 IUs per day of oral vitamin D 3 [ 97 , 98 , 99 ]. However, the benefit of lower doses of up to 4200 IUs per day or equivalent of vitamin D supplements for the treatment of psoriasis is still unverified based on the results of a few clinical trials [ 100 ].…”

Dietary Intervention and Supplements in the Management of Psoriasis: Current Perspectives

“…70 , 72–74 Topical vitamin D analogues like calcipotriol and calcitriol have long been a part of standard dermatological treatment for psoriasis, but the efficacy of oral vitamin D supplementation remains unclear. 75 Although numerous studies have shown vitamin D as a popular supplement for patients, 3 , 4 , 6 clinical trial data have shown conflicting evidence, with the most recent NPF guidelines written in 2018 stating that oral vitamin D was not recommended for psoriasis patients. 7 More recent studies and meta-analyses have found similar outcomes—results continue to be mixed on efficacy, though few adverse effects tend to be noted in treatment groups.…”